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Chronic Pain (cont.)

Complications of Opioids

Nausea and vomiting: These are common side effects at the beginning of opioid therapy. If they are a problem, they can be controlled with nonprescription medication for nausea such as meclizine (Bonine, Dramamine), or diphenhydramine (Benadryl), or, in some cases, by prescription medication such as prochlorperazine (Compazine) or haloperidol (Haldol). The nausea and vomiting usually stop within a few days, and then the antiemetic (antinausea and vomiting) medication can be stopped.

Dizziness: Dizziness and sleepiness are common when you take opioids. That is why it is recommended that patients not drive, drink alcohol, or operate machinery while taking opioids. People who have chronic pain often develop tolerance for this side effect of opioids, and often can do all the normal activities of daily living while on opioid therapy.

Constipation: Opioids always cause this problem, and constipation continues to be a problem for as long as the patient takes opioids. Constipation can become a serious problem if the patient does not keep it under control. The stool can become totally blocked off (fecal impaction) to the point at which manual disimpaction must be performed. Stool softening medications such as docusate can help prevent or relieve constipation.

Addiction: Hospice patients worry about becoming addicted to opioids. With hospice, however, it is rarely an issue. People with chronic pain also worry about addiction, but it turns out that for most adults, if they do not already have a substance (alcohol or drug) abuse problem, addiction is not much of an issue even when opioids are used on a long-term basis.

  • A study was done in which 12,000 nonaddicted people who needed opioids were followed up to see if they had become addicted. Four out of 12,000 showed addictive behavior (less than one tenth of 1%).
  • Generally, the only people who develop addictive behavior after being given opioids, had an addiction problem before the opioids were given for pain. Most people take opioids until the pain goes away. Then they stop taking them because they do not want to feel dizzy or drowsy. Once the pain goes away, the toxic side effects of dizziness and drowsiness come back.
  • Anyone who takes any medication just to "get high" is already showing addictive behavior and needs to stop taking addictive substances, including opioids, other addictive drugs, and alcohol, immediately.
  • Some people with actual painful illnesses are addicted to mind-altering substances. They get prescriptions because of their actual illnesses. Normally, the dose of opioids is arrived at by the patient telling the doctor how they are doing with the pain and by participating in their activities of daily living. A chronic pain patient who is not addicted to medication will tell the doctor the truth about his or her ability to function and do what needs to be done in daily life.
  • Addicts will lie about performing activities of daily living. The addict will claim that the pain is so severe that they need a higher dose until they get to a dose that causes them to sleep most of the time. Then, they will tell the doctor that they are doing fine and are able to do all the activities that they need to do.
  • Selling narcotic pain medicine to others is a federal crime.
  • Family members should discuss their concern with a health care professional if they suspect the patient may be addicted to pain medication. When an addicted person actually has a painful syndrome, the doctor, with the help of the family, may have to decide what the dose of medication should be, without reference to the dose the pain patient thinks would be best. Sometimes, in severely addicted people, the opioids should not be used at all. Some addicted people can be treated with opioids if necessary as long as they cooperate carefully with the treatment plan.

Respiratory depression: The most dangerous complication of opioid therapy is respiratory depression. A lot of people know that some drug addicts have been known to get pure heroin or fentanyl, and then die with the needle still in their arm because they fell asleep and didn't breathe. That happens because of a huge overdose in a patient who is not in pain. Pain is a potent stimulator of the respiratory center in the brain. So if a person has pain, and the doctor increases the dose of opioids carefully until the pain is controlled, and then stops raising the dosage, the patient will not get respiratory depression.

Fortunately for people with pain, large doses of opioids can safely be used if they are necessary to combat severe chronic pain.

Living With Chronic Pain

It is not always possible to completely get rid of chronic pain. The patient's goal may be simply becoming able to perform more normal activities of daily living than before.

  • The doctor may ask the patient to rate the pain on a scale from 1 to 10.
  • It is also helpful to report whether it is possible to go to work, go shopping, exercise, sleep, or have sexual intercourse.
  • Sometimes, the only measure of effectiveness of treatment is that a patient can do certain things that were not possible before the treatment started. This is what the doctor needs to know in order to make decisions about the patient's treatment.
  • If nothing else works for the patient's pain and the doctor is unwilling to use opioids to control the pain, consider asking for a referral to a pain specialist or a pain clinic.

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology


The American Chronic Pain Association.

World Health Organization. WHO's pain ladder.

Last Reviewed 11/21/2017

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